*1.Have you heard of the Campus Care Clinic at Topeka High School?(Required.)

Yes

No

2.If yes, how did you hear about the clinic?

*3.Have you used the Campus Care Clinic for a healthcare need?(Required.)

Yes

No

4.If you have not used the Campus Care Clinic, why not? (select all that apply)

I had not heard about the clinic.

I already have a healthcare provider.

I have concerns about cost/insurance.

I haven’t had a healthcare need but would use it if I did.

Other (please specify)

*5.Which represents your affiliation with TPS 501? (select all that apply)(Required.)

I am a faculty member.

I am a student.

I am a parent/guardian of a student.

Other (please specify)

*6.What TPS 501 school are you affiliated with?(Required.)

7.Please share any ideas you have that you would like to see from the Campus Care Clinic.